Prognostication Strategy

At the 2017 International Symposium on Intensive Care and Emergency Medicine, the experts in this field suggested a strategy for treating physicians. This has further developed through joint collaboration by European Resuscitation Council (ERC) and European Society for Intensive Care Medicine (ESICM) in 2021 and 2025. [2]

The key principles of this strategy are [9]:

Early Communication with the next of kin

It is important to provide early and meaningful information to the patient’s next of kin. This makes them aware of the patient’s critical condition and enables the physician to better understand the expectations of families/friends. It is however vital to convey that physicians will take decisions in the best interests of the patient.

Delay the timing of prognostication

The current recommendations are to consider prognosis in the unconscious patient at ≥72hrs from ROSC once confounders have been excluded. The phenomenon of ‘late awakening’ has been observed and an extremely small number of patients who do not respond for 5-7 days recover with intact neurology.

Use of Multimodal Evaluation tool for prognostication

ERC/ESICM also recommend that in patients who are comatose after resuscitation from cardiac arrest, neurological prognostication should be performed using clinical examination, electrophysiology, biomarkers, and imaging. This is discussed subsequently in further detail. [2]

Be patient

This a key attribute and the treating physician should approach individual cases differently but follow the suggested principles. There is no harm in involving your fellow colleagues in the decision-making process.